Journal of the Royal Society of Medicine
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Although the number of doctors abused is comparatively small, the perceived risk of violence presents a major issue for the whole profession since the consequences extend to all doctors through the intimidation reports in the medical press and newspapers engender.
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Dr Adams was previously consultant anaesthetist to Addenbrooke's Hospital, Cambridge, with a special interest in ophthalmic and neuroanaesthesia, and Associate Lecturer in Cambridge University. She was Dean of the Faculty of Anaesthetists of the Royal College of Surgeons of England in 1985, now the Royal College of Anaesthetists, of which she is currently Honorary Archivist/Curator. ⋯ Within the RSM she was president of the Section of Anaesthetics in 1985-1986 and of the Section of the History of Medicine in 1994-1995, having served as Honorary Secretary of each. She is now an Honorary Treasurer of the Society.
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The Compression of Morbidity hypothesis envisions a potential reduction of overall morbidity, and of health care costs, now heavily concentrated in the senior years, by compression of morbidity between an increasing age of onset of disability and the age of death, increasing perhaps more slowly. For this scenario to be able to be widely achieved, largely through prevention of disease and disability, we need to identify variables which predict future ill health, modify these variables, and document the improvements in health that result. Physical activity is perhaps the most obvious of the variables which might reduce overall lifetime morbidity.
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In order to determine symptoms, drug prescribing and physical problems of patients referred to an inpatient hospice, case notes from 130 consecutive first admissions (95 general practitioner (GP) referrals, 35 consultant referrals) were analysed. GP referrals were more likely to be constipated, require care and be discharged to home. Consultant referrals were more gravely ill, dependent and more likely to die in the hospice. ⋯ GPs experienced difficulties frequently or always in: (a) managing pain (8/79); (b) managing other symptoms (25/79); (c) helping patients and relatives cope with their emotional distress (18/79); and (d) coping with their own emotional responses to death and dying (5/79). In conclusion, the differences demonstrated between the GP and consultant referrals have implications for purchasers. The high incidence of possible opiate-induced side-effects and the difficulties with symptom control expressed by some GPs indicate a continuing need for effective educational input.